Kondisi optimal PCR untuk mendeteksi gen FimH isolat klinis Escherichia coli penyebab infeksi saluran kemih

Background: Urinary tract infection is one of the most common infectious diseases and the second most common infection after respiratory tract infection. Bacteria are the most common cause of urinary tract infections in more than 95% of cases. Escherichia coli is the most common bacteria that found in 80-90% of cases of urinary tract infection. The critical virulence factor of Escherichia coli is the type 1 fimbriae with the adhesion subunit, fimH, plays an essential role in the pathogenesis of urinary tract infection.

Aim: The research aims to obtain the optimal condition of PCR in detecting the fimH gene with modification of annealing temperature in the PCR process.

Method: This study used a sample of fimH DNA genes from clinical isolates of E. coli causing UTI. The second PCR used an annealing temperature of 57°C and a third PCR using an annealing temperature of 64°C. The electrophoresis results are then viewed with an ultraviolet transilluminator.

Result: The optimization finding showed that the annealing temperature of 52 °C, 57 ° C, and 64°C could detect the fimH gene where the higher the temperature used by T_m, the less the specificity produced.

Conclusion: The optimum annealing temperature of PCR to identify the fimH gene from E.coli causes the UTI is in the temperature of 64°C with better specificity than of 52°C. The annealing temperature of 64°C indicates the lowest specificity.

Hubungan asupan serat dengan angka kejadian kanker kolorektal di RSUP Sanglah Denpasar tahun 2016 - 2017

Background: Colorectal cancer is one of the most common cancer in Indonesia. The etiology of colorectal cancer is still unknown, but many risk factors believed may causing colorectal cancer, one of them is fiber intake of foods consumed every day like vegetables, fruits, and peanuts. There is an instrument that can be used to assess fiber intake per day.

Aim: The study aimed to know how the correlation between fiber intake and colorectal cancer patient are in Sanglah General Hospital.

Method: The design is a case-control analytic study, obtained total of 104 samples that divided into case group (52 samples) and control group (52 samples), in which secondary data with medical record data and also primary data with questionnaire are collected. Data were analyzed using the SPSS program.

Result: Of the 104 samples that divided into case group and control group with 1:1 ratio, patients who diagnosed with colorectal cancer had a history of low fiber intake higher 6.75 times than peoples who not diagnosed with colorectal cancer (OR=6.75; 95% CI 2.85-15.96; P<0.001).

Conclusion: Patients who diagnosed with colorectal cancer had a history of low fiber intake per day higher 6.75 times than samples which did not diagnose with colorectal cancer.

Perbandingan asupan makronutrien antara anak obesitas dengan normal pada siswa kelas 4-6 di Sekolah Dasar Santo Yoseph 2 Denpasar tahun 2017

Background: Childhood obesity is a disturbance of nutritional status in children with body mass index per age (BMI / U) exceeding> 1 standard deviation (SD) - 2 SD followed by unbalanced diet between intake and output accumulated in excess fat storage. There are some related factors for obesity such as unbalanced diet, lack of physical activity, and the environmental agents.

Aim: This research aims to find out the correlation between macronutrient intake with child obesity in grade 4-6 students at Santo Yoseph 2 Denpasar Elementary School.

Method: The study was an analytical cross-sectional design with 60 samples obtained from random sampling technique and interviewed with questioner (SQ-FFQ) and then measured the height and weight in the period March-August 2017. Those interview data was processed with Nutriesurvey9^© and analyzed with SPSS.

Result: 60 samples showed the dominant child obesity occurred in male gender (70.0%). The proportion of child obesity by age group was highest at 10-12 years (51.2%). Analysis of the relationship of macronutrient intake with child obesity was obtained for energy intake (p = 0.007), protein (p = 0.009) and fat (p = 0.018) intake was p < 0.05, while carbohydrate (p= 0.074) p > 0.05.

Conclusion: This study shows that there is a statistically significant relationship between energy intake, protein, and fat with child obesity. Reversely, carbohydrates, there is no statistically significant association with childhood obesity.

Overview of drugs used for the treatment of hypertension for elderly patients in Sanglah General Hospital, Denpasar, Bali

Background: Hypertension is one of the most common diseases among elderly patients and it is also known as a silent killer. It could be due to excessive stress which causes the blood pressure to rise. The symptoms could appear, and people could go on for years without having any awareness of their disease.

Aim: This research was conducted to determine the prevalence of hypertension cases of elderly patients and the drugs used as a treatment for hypertension in Sanglah Hospital, Denpasar, Bali. The research was carried on in the Sanglah Hospital, Denpasar, Bali as of January until June 2017.

Method: In this study, a descriptive cross sectional study method was being used.

Result: As the age increases, the number of individuals with hypertension increases. In gender, we could see that the female has a higher prevalence compared to male. In Sanglah, we found that the mostly given drugs are amlodipine and captopril for elderly people as this drug works effectively for the patients. Other drugs such as valsartan, furosemide, and bisoprolol are also offered to patients with hypertension depending on their associated diseases.

Red meat intake as a suspicious factor of colorectal cancer at Sanglah General Hospital in 2017

Background: Colon and rectal cancer (colorectal cancer) is cancer with high morbidity and mortality. Colorectal cancer is the second leading cause of death among men and women. This cancer is also the third most common malignant neoplasm in the world, and its incidence has increased in recent years. A high diet of red meat is one of the risk factors that can increase the likelihood of colorectal cancer.

Aim: The study aims to determine the relationship between red meat consumption on the incidence of colorectal cancer.

Method: This study is an unmatched paired case-control study conducted in Sanglah Hospital using patient medical record data from 2016 to 2017. The number of colorectal cancer group and control group samples are 52 people, each group. Samples were then interviewed on the red meat diet using the questionnaire guidelines. Data on the diagnosis of colorectal cancer was obtained through the patient's medical record at Digestive Surgery Polyclinic, Sanglah Hospital, Denpasar.

Result: About 76.9% of colorectal cancer patients consume a high intake of red meat. Patients with colorectal cancer have a history of higher red meat intake than patients without colorectal cancer (OR = 9.048; 95% CI 3.716-22.026; p<0.001).

Conclusion: Red meat intake is a significant factor in the incidence of colorectal cancer in Sanglah Hospital. Limiting the consumption of red meat is recommended to reduce the risk of colorectal cancer.

Pola Kuman dan Uji Kepekaan Antibiotik Pada Pasien Unit Luka Bakar RSUP Sanglah Periode 1 Januari 2016 - 1 Januari 2017

Background: Burns are a skin injury or injury caused by thermal that causes morbidity or mortality in patients, due to either heat or radiation, electrical and chemical reactions. In burns can occur bacterial growth that will cause an infection, both gram-positive bacteria and gram-negative bacteria. Necessary antibiotics in the treatment of infection by bacteria on burns. The incidence of burns is increasing from year to year, but data in Indonesia that discuss about the number of infections in burns and the use of antibiotics is still small.

Aim: The study aims to determine the pattern of germs and antibiotic sensitivity test in patient burn unit at Sanglah Denpasar Hospital period January 2016 - January 2017.

Method: This research is a descriptive descriptive cross sectional study conducted at Sanglah Denpasar General Hospital (RSUP). Data obtained in the form of secondary data of medical record of patient period January 2016 - January 2017. Data were analyzed by using SPSS program.

Result: The results showed that from 63 patients, found 51.0% gram positive and 49.0% gram negative. In the positive gram found 8 species of bacteria with the most bacteria that is Staphylococcus aureus 15.87% and Strep β Haemolyticus 15.87% and gram negative found 3 types of bacteria with the highest number Pseudomonas aeruginosa 30.16%.

Conclusion: Antibiotics with the highest resistance were found Amoxicillin 85.7%, Amoxicillin / Sulbactam 81.2% and Ampicillin 87.5% while the highest sensitivity antibotics were Amikacin 82.3%, Meropenem 75.0% and Linezolid 85.7% both on gram negative and gram positive.

The influence of light physical activity on scale of pain in elderly with knee osteoarthritis

Background: Osteoarthritis (OA) is a collection of mechanical variations of joint thinning, including the articular ligament and the subchondral bone.

Aim: This study aims to find out how some light physical activity correlates with the pain scale among elderly with knee osteoarthritis and also to find out whether light physical activity in the elderly helps reduce pain in knee osteoarthritis.

Method: This research is a descriptive cross sectional study. The sample in this study was elderly people aged 50 years and above with a total of 70 samples were selected using multistage random sampling technique located in Badung Market, Kumbasari Market, and Renon Field. Data were obtained by interviewing respondents who previously provided informed consent using structured questionnaires. The degree of pain caused by osteoarthritis was measured using The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the total score.

Results: Distribution of sex within samples found that women (54.3%) and men (45.7%). Researchers found that the mean age of respondents was 61.2 (SD + 3.75) years. The total number of respondents who have exercise habits is 52.9%. The average WOMAC score was 23 (SD +2,319) with a minimum score of 18 and a maximum of 27. Respondents with WOMAC score <23 were 52.9% whereas respondents with WOMAC score> 23 were 47.1%. Cross-tabulation results showed 97.3% of respondents with a WOMAC score <23 had exercise habits.

Conclusion: The exercise habits of the elderly with knee osteoarthritis can reduce pain when measured using a 0-4 scale and the WOMAC pain scale.

Pengaruh kepatuhan pendokumentasian asuhan medis terhadap kelengkapan dokumen pengajuan klaim JKN di Instalasi Rawat Inap RSUD Badung tahun 2018

Background: BPJS as a health insurance institution runs the National Health Insurance (JKN) program. JKN implements a prospective financing system whereby payments made after the provision of services are in accordance with the agreement at the beginning in the form of packages. As regard with the fee, the hospital should take an effort to submit the proof document as the condition for the filing of the claim.

Aim: This study aims to determine the effect of medical documenting compliance with the completeness of the JKN claim filing documents at the inpatient installation of Badung Hospital.

Method: This study is a cross-sectional analytic study with the sample used is 120 documents of in-patient medical treatment that has been repatriated at the in-patient installation of Badung General Hospital in February 2018.  

Results: This research get result that the price r_s = 0.861 and p-value = 0,003.

Conclusion: There is an effect of compliance with documenting medical care on the completeness of claim filing documents in the in-patient installation of Badung General Hospital.

Gambaran hasil pemeriksaan faal hemostasis pada penderita Diabetes Melitus tipe-2 (DM-2) di RSUP Sanglah, Bali, Indonesia

Background: Diabetes Mellitus Type II (DM-2) is a type of hyperglycemic state which is related to metabolic disorders caused by mutations in several genes. Faal hemostasis is a function of the body that aims to maintain the blood that has been thinned so that the blood flowing in the veins and could be interfere with blood glucose level. This study aims to describe the faal hemostasis examination in patients with DM-2 in Sanglah Hospital.

Methods: A cross-sectional study was conducted among patients with diabetes mellitus type II (DM-2) who were hospitalized in Sanglah hospital at the period started from January 1^st to December 31^st, 2015. The sample selection were using consecutive sampling with a total of twenty eight samples. Data were analyzed using SPSS version 17 for Windows

Results: The study found that males were predominant in this study (53.6%). In addition, 51-60 years age group were also predominant (39.3%), following by history of hypertension (82.1%), 10-14 seconds of Prothrombin Time (PT) (67.9%), 30-40 seconds of Activated Partial Thromboplastin Time (APTT) (53.5%), and bleeding time (BT) > 1.3 minutes (67.9%).

Conclusion: Several faal hemostasis assessments were predominant in patients with DM-2 such as 10-14 seconds of PT, 20-40 seconds of APTT, and bleeding time more than 1.3 minutes.

Awareness of colorectal cancer risk factor among students at Faculty of Medicine, Udayana University, Bali

Introduction: Colorectal cancer is a major cause of morbidity and mortality throughout the world. To identify the presence of colorectal cancer, screening that is recommended can be carried out. Screening is an important process in every disease including colorectal cancer

Method: This is crossectional-descriptive research. 100 samples that met inclusion criteria were included in the research. Samples obtained using consecutive sampling technique. The samples were interviewed to obtain the data used to fill out the questionnaire

Result: 74% of the student has answered that a history of personal cancer are risk factors of colorectal cancer and also 88% of students have answered family history also a risk factor for colorectal cancer. The students have less knowledge on risk factors such as Inflammatory Bowel Disease (64%) and eating spicy food (60%). 87% of students agree that knowledge on colon and rectal cancer is important to prevent colorectal cancer.

Usia dan obesitas berhubungan terhadap penyakit batu saluran kemih di RSUP Sanglah Denpasar periode Januari 2014 sampai Desember 2014

Introduction: Urinary Stone Disease is the process of forming stones caused by the deposition of a substance with excess amounts of urinary or due to other factors that affect the solvency of substance. Urinary Stone Disease is frequently   found on adults between 15-59 years old. Total patient who diagnosed by Urinary Stone Disease in Indonesia is too high. Many things associated against the onset of this disease, such as age and obesity. Therefore the research to examine which factors cause the occurrence of Urinary Stone Disease is necessary in order to raise the early prevention.

Method: Research design is descriptive analytic. Using consecutive sampling method. Data will be analyzed in univariate and bivariate using statistical test of chi-square with a level of significance of α < 0.05. Place of research in Sanglah Denpasar Bali Subject of research are men and women above 15 years old, diagnosed with Urinary Stone Disease. Subject research are urology unit visiting patient also patient being hospitalized at Sanglah General Hospital.

Result: The research results showed that the age has become risk factors which closely related with Urinary Stone Disease, value of p = 0.002. Obesity does not have significant relations against the occurrence of Urinary Stone Disease with value of p = 0,564.

Hubungan insomnia dengan depresi pada lanjut usia di Sesetan Kecamatan Denpasar Selatan Tahun 2017

Introduction: Insomnia is difficulty falling or maintaining sleep that often experienced by general population. Insomnia mostly experienced by elderly woman, people with low education and low economy and in people  who  have  chronic  disease.  Insomnia  is  risk  factor  from  psychiatric  disorder  especially depression. Insomnia increase the risk in depression development. Depression is disorder on personal, interpersonal  and social that affecting general population. The purpose of this study is to know the relationship between insomnia and depression in elderly.

Method: The type of this study is analytical observational (Cross-sectional)  study with amount of sample 32 respondents that conducted in Banjar Gaduh and Banjar Tengah in Sesetan, South Denpasar District in elderly in 2017. This study is using the primary data obtained through questionnaire and interview (GDS and ISI) and analyzed through SPSS 21.0.

Result: This study found that from 32 respondents experienced insomnia (50%), not experienced Insomnia   (50%),  experienced   depression   (28.1%)  and  no  experience   depression   (71.9%)  and relationship insomnia with depression on eldery obtained value p < 0.05 . The R-square value indicates value of 0.673 which means that role variable independent in explain variable dependent only of 67.3%, could be concluded that still there are 24.6% other variables outside the research variables that affect insomnia.

Conclusion: There were a significant relationships between depression and insomnia.

Perbedaan stress kerja pada perawat di ruang unit gawat darurat dengan perawat di ruang rawat inap Rumah Sakit “S” di Kota Denpasar tahun 2017

Hubungan lingkar perut dengan kadar gula darah puasa pada mahasiswa Fakultas Kedokteran Universitas Udayana angkatan 2014

Introduction: Diabetes Mellitus is a metabolic disease characterized by elevated blood sugar levels, either caused by a disturbance of insulin secretion, insulin resistance or both. Obesity is one of the risk factors of diabetes mellitus. The incidence of diabetes mellitus increases from year to year, but the data that discusses the association of risk factors with diabetes mellitus itself, especially obesity is minimum. The purpose of this study is to determine the association of abdominal circumference with fasting blood sugar levels at students of Udayana University Faculty of Medicine class of 2014.

Method: This research is an analytical research conducted at Udayana University Faculty of Medicine Campus, Denpasar. Data obtained in the form of primary data in the form of abdominal circumference to see the status of obesity and fasting blood sugar to see the status of diabetes mellitus. Data were analyzed using SPSS program.

Result: The results showed that there was not significant negative association between abdominal circumference with fasting blood sugar levels at Udayana University, Faculty of Medicine students class of 2014. However, this association is not statistically significant because diabetes mellitus influenced by many factors other than obesity. In addition, it can be seen that the characteristics of the population did not describe the population of diabetes mellitus or obesity, thus affecting associations that have been described in some literature and the concept of author thinking. But indeed the association of anthropometric risk factors (abdominal circumference) has a greater value than other risk factors.

Conclusion: There was a negative correlation between abdominal circumference and fasting blood sugar but not significant statistically

Hubungan antara obesitas dan insiden kanker kolorektal di RSUP Sanglah tahun 2016-2017

Introduction: Colorectal cancer is the third malignant disease in Indonesia. Obesity is one of the risk factors related to colorectal cancer. This research aims to role out relationships between obese and age to the incidence of colorectal cancer at Sanglah General Hospital.

Method: Study design using case-control analytic model, covering 274 samples, divided into the group of colorectal cancer (137 persons) and non-cancer samples (137 persons). Secondary data were used for analysis obtained from medical records in year period of 2016-2017 at Sanglah General Hospital. Data were analyzed using Chi-square analysis and risk estimate model.

Result: The result showed that the majority of colorectal cancer patients were male (53.3%), meanwhile for non-cancer patients were female (50.4%). The average age of colorectal cancer patients was 54 years old while 42 years for non-colorectal cancer patients. Based on the BMI groups, majority of cancer colorectal patients (62%) belongs to obese, while only 39.4% for non-colorectal cancer patients. Result of analysis showed that there is significant relationship between obese and the incidence of colorectal cancer (p value <0.001), with the risk increase of prevalence by 1.588 times higher for those patients with BMI ≥23.00 kg/m² (95% CI 1.235-2.040). Result from the Chi-square test also indicated that there is significant relationship between age above 40 years and the incidence of colorectal cancer (p value <0.001).

Conclusion: It can be concluded that there is significant relationships between obese and age above 40 years to the incidence of colorectal cancer.

Gambaran fraktur elbow pada anak-anak di RSUP Sanglah tahun 2012-2013

Introduction: Fracture is a loss of bone continuity, either total or partial, usually caused by trauma. Fractures in children are more common due to the immature musculoskeletal system, this is because the child is more susceptible to tears on joint surfaces, epiphyseal plates, aphophyseal insertion of large tendon muscle units. This study aims to determine the prevalence of elbow fracture in children at Sanglah Hospital Denpasar in 2012 until 2013.

Method: Study design using cross-sectional method, evaluating the characteristics of elbow fracture in children at Sanglah General Hospital in the period 2012 to 2013.

Results: Males tend to have more elbow fractures compared with females with a 73% proportion, based on the cause of overall fracture of the sample due to falling during activity, based on the fracture type  more subjects experiencing fractures of the supracondylar humerus fracture compared with olecranon fractures as much as 93%.

Conclusion: The prevalence of elbow fracture in children in Sanglah General Hospital in 2012-2013 is 15 cases, all caused by falling during the activity. The type of elbow fracture found in most children is a supracondylar humerus fracture.

Gambaran umum berbagai faktor keterlambatan pemberian nutrisi enteral pada pasien anak di Ruang Rawat Intensif Anak, RSUP Sanglah, Denpasar, Bali

Background: Enteral nutrition is the primary choice in pediatric patients who do not experience gastrointestinal disorders. Many factors inhibit the achievement of enteral nutrition in pediatric patients treated in intensive care. This study aims to determine the overview of various factors that may result in delays enteral nutrition administration in critically ill pediatric patients

Methods: An observational cross-sectional analytic study was carried out on secondary data of medical records among children who were treated in pediatric intensive care unit at Sanglah Hospital throughout 2016. Delay in enteral nutrition was assessed if there was enteral nutrition administration more than 2x24 hours since first admission. Factors assessed include gender, age, PELOD, diagnosis, invasive breathing aids, impaired motility, gastrointestinal bleeding, and hemodynamic instability. Data were analyzed using the SPSS version 20 software program whereas P value <0.05 was considered statistically significant.

Results: From the 115 samples, there were 69 (60%) males and 46 (40%) females. About 50 samples (43,5%) experienced delayed enteral nutrition. Significant variables related to the delay in enteral nutrition after multivariate analysis were gastrointestinal motility disorders (p = 0,004, OR 9,082, 95% IK 2,827 – 29,171), and gastrointestinal bleeding (p = 0,0001; OR 14,317; IK 95 % 4,087 – 50,155).

The effect of young pepaya leaf ethanol extract (Carica papaya L.) with concentration variants on the growth of pathogenic Streptococcus pyogenes bacteria causing pharyngitis through in vitro testing

Background: Pharyngitis infection issues by Streptococcus pyogenes bacteria have been increasing worldwide, and antibiotic resistance to the bacterium treatment also continues to escalate. Young papaya leaves (Carica papaya L.) have a bactericidal and bacterostatic effect (include papain, flavonoids, alkaloids (karpain alkaloids), saponins, glycosides, phenols (tacophenol), and tannins) that can be an option for treatment of pharyngitis infections other than drugs. This study aims to determine the effectiveness of ethanol extract of young papaya leaves (Carica papaya L.) in inhibiting the growth of Streptococcus pyogenes bacteria through in vitro testing.

Methods: This study was a true-post experimental study using control group design. The sample was divided into 2 groups: positive and negative control groups as well as treatment groups with concentration variants of 25%, 50%, 75%, and 100%. Data were analyzed using SPSS version 17 software for windows.

Results: The result obtained from this study showed that papaya leaf extract (Carica papaya L.) was proven to significantly inhibit the growth of Streptococcus pyogenes bacteria at concentrations of 25% to 100% with an average diameter of the inhibition zone of 6.4 mm to 7.4 mm (P<0.05).

Conclusion: This evidences that the ethanol extract of young papaya leaves (Carica papaya L.) with various concentrations does exhibit an influence on the growth of Streptococcus pyogenes bacteria.

Hubungan komunikasi efektif dokter-pasien terhadap tingkat kepuasan pasien dalam pelayanan medik

Introduction: Indonesia is the biggest contributor of medical tourists to Malaysia and Singapore in recent years, mostly from Medan. Literature reviews and experts opinion of community medicine revealed that poor doctors’ communication skills in Indonesia lead to decreased patients satisfaction and lead to the number of patients seeking treatment abroad.

Aim: This study aimed to analyze the relationship between physician-patient communication on the level of patient satisfaction in Central Public Hospital Haji Adam Malik, Medan.

Method: This research uses a combination of descriptive-analytic study with cross sectional design. Statistical analysis was performed by chi-square test. The sample selection of research done by consecutive sampling. Measurement doctor-patient communication and patient satisfaction rate is determined by using modified CAT (Communication Assessment Tool) questionnaire.

Result: Ten outpatient clinics of Central Public Hospital Haji Adam Malik (10 patients per outpatient clinic) participated in the field test. The average mean score was 4.086 across all modified CAT items (SD = 0.609, range 2.23-5.00). The average proportion of satisfaction rate was 81.7% (S.D. = 12.19, range 44.62-100%). There was a significant relationship between physician-patient communication with patient satisfaction (p <0.05).

Prevalensi dan karakteristik obesitas pada anak di Sekolah Dasar Saraswati V Kota Denpasar tahun 2016

Introduction: One of the problems of excess nutrients that occur in children and received special attention in the world of health is obesity. Obesity itself can be defined as the accumulation of excess fat raises the risk of health problems. The prevalence of obesity in children in the world between 1980 and 2013 increased by 47.1%. Childhood obesity has both immediate effects and long-term health. This study aims to determine the prevalence and characteristics of obesity in children at elementary school.

Method: This research is a descriptive cross sectional study, conducted in Saraswati V Denpasar elementary school, November - December 2016, by taking samples of obese children in Saraswati V elementary school Denpasar 2016.

Result: From the results, 17.2% children with obese, 18.2% children with overweight, 54.6% children with normal BMI, and 10.0% children with underweight from total students many as 1003 children. While the characteristics of obese children obtained: 62.2% of obese children aged <9 years, 73.4% of obese children of boy, 86.7% of obese children have birth weight ≥2500 gram, 62.9% do breakfast, 98,6% escorted to school, 67.8% had obese father and 34.3% had obese mothers, 99.3% had educated father and 97.2% had educated mother.

Displasia ektodermal tipe hipohidrotik pada seorang anak bayi tiga tahun

ABSTRACT

Introduction: Ectodermal dysplasia (ED) is a rare genetic disorder characterized by defect in two or more ectodermal structures such as teeth, hair, nails and sweat glands. Ectodermal dysplasia divided into 2 types, which is hidrotic and hypohidrotic. The hypohidrotic type was found in 80% of cases. There is no specific treatment for this disorder, which is more of a symptomatic measures depends on the structure involved.

Case: A 1 year old male, Balinese, consulted from Department of Pediatrics to Department of Dermatovenereology with the chief complaint of dry skin, absence of sweat, teeth, scalp hair and eyebrow since birth. Recurrent fever present especially in hot climates. No growth abnormalities. No history of incest between parents. His grandfather also complained about the same symptoms, which are sparse hair and decreased sweating. General examination revealed frontal bossing, saddle nose, prominent chin and anodontia. Dermatologic examination revealed multiple hypopigmented macules, well defined margin, oval-round shaped, size ø 0,5-1 cm, distributed over entire skin and anhidrosis. Department of Dermatovenereology gives moisturizer every 12 hours topically. Department of Pediatrics gives zinc tablets, 20 mg every 24 hours orally.

Conclusion:The diagnosis of ED was mainly clinical. Treatment is symptomatic and effective education is needed to increase patient's quality of life. Early fetal detection can be performed if there is a risk in the family. Currently, there is a team joined under SIDIC program in Sanglah Hospital whose main purpose is to detect and prevent congenital disorders early.

Perbedaan rerata kadar protein-C pada sepsis neonatorum dengan kultur positif dan negative di RSUP H. Adam Malik Medan tahun 2018

Background: First ten months from conception is a period of susceptibility to infection. Diagnostic testing for disease must be conducted as quickly as possible for antimicrobial administration. Blood culture, the 'gold standard' for diagnosis, is full of shortcomings. Decreasing protein C levels are characteristic of sepsis due to an increase in consumption, degradation, or decreased synthesis, so that the onset of protein C deficiency may occur before the diagnosis of sepsis.

Aim: The study aimed to determine the difference in mean serum C protein levels in septic neonatorum in which positive cultures compared with negative cultures

Methods: The sample in this study were septic neonatorum patients in the perinatology unit of H. Adam Malik General Hospital Medan by consecutive sampling technique. The blood was incubated in BACTEC 9050 and identified with gram staining, gram-positive identified by catalase, coagulase and MSA tests, while gram-negative with API 20E. Protein C was examined with Coatron A4. A bivariate analysis determined differences in protein C in septic neonatorum with positive and negative cultures.

Result: The prevalence of positive culture sepsis was 36.1%. The most common pathogens were Staphylococci epidermidis (19.4%). There was no significant difference in protein C levels between the septic neonatorum with positive and negative cultures (p = 0.166). Positive culture sepsis is a risk factor associated with protein C decreasing with p = 0.011. Positive culture sepsis had a higher risk of reducing protein C levels by 7.536 times compared to negative culture sepsis.

Conclusion: There were no significant differences in protein C levels between septic neonatorum with positive and negative cultures, but sepsis was significantly associated with a decrease in C protein levels.

Analisis hubungan Rasio Trombosit Limfosit (RTL) dengan derajat keparahan stenosis pada pasien Coronary Artery Disease (CAD)

Background: Atherosclerosis in CAD is marked by formation of plaque inside the arterial lumen. Platelet plays a role on formation and development of atherosclerosis. Adhesion of platelets to the endothelial cells followed by releasing platelet granules caused inflammation of endothel. Lymphocytes also play a role in atherosclerosis and atherotrombosis. T lymphocyte was the first to be recruited inside atheromas and gathered along inside an unstable plaque. The severity of stenosis can be calculated using Gensini score. The Aim of this study is to analyze the correlation between PLR and degree of stenosis in CAD.

Methods. This study is a retrospective study by collected 110 patients with CAD that had undergone coronary Angiography. Platelets and lymphocyte count were measured by automatic haematologycal analyzer. PLR was measured by dividing trombocyte count with absolute lymphocyte. Angiography findings were calculated using Gensini score and later devided into 3 groups according to degree of severity.

Results. 110 patients retrospectively assesed, 80% were male and 20% female. The most age found was 50-59 years (35.5%). Using Anova test there is a significant differences on  PLR between 3 groups of lesions (p<0.05). Continued with Posthoc test, the only significant finding was PLR between moderate and severe lesion. By Spearman’s Correlation test, there is a positif colleration between PLR and severity of stenosis (p<0.048), with R value 0.189 (3.6%).

Conclusions. There was a poor correlation between PLR and degree of stenosis severity in CAD. A prospective study needed to assess PLR as predictor of mortality and morbidity in CAD.

Analisis Corrected Count Increment (CCI) pada penderita post transfusi trombosit apheresis di RSUP Dr. Wahidin Sudirohusodo, Makassar, Indonesia

Background: Platelet refractoriness is a problem in the implementation of platelet transfusion. It is a lack of increased platelets after platelet transfusion. This study aimed to analyze the increase in platelet counts of patients who received apheresis platelet transfusion by using Corrected Count Increment (CCI) formula at Dr. Wahidin Sudirohusodo General Hospital Makassar.

Methods: This was an observational cross sectional study with 242 thrombocytopenia patients. The success of platelet transfusion was calculated using the CCI formula with CCI values after transfusion of 4.5 x 10⁹/L at 24 hours post transfusion. Statistical analysis used chi square, t-independent, and spearmen’s correlation test, with significant test results if p-value was < 0.05.

Results: An average increase of platelet counts was 28.5 x 10⁹/L. Successful thrombocyte transfusion was found in 107 subjects (44.2%) and unsuccessful in 135 subjects (55.8%). The proportion of successful transfusion was found to be higher in men (45.5%) than women (43.2%), however, it was not significant (p > 0.05). There was a significant relationship between young age and successful thrombocyte transfusion (p < 0.001). Unsuccessful transfusion rate was high in cases of malignancy, infection, bleeding, and metabolic disease (p < 0.05).

Conclusions: There was a significant negative correlation between age and CCI, older age presented lower value of CCI. Characteristics of disease affected the successful of apheresis thrombocyte transfusion.

Nilai rasio netrofil limfosit dan rasio trombosit limfosit pada pasien chronic kidney disease sebelum dan setelah hemodialisa

Background: CKD is a world health problem with an increasing incidence, having a poor prognosis and requiring expensive treatment costs. Cardiovascular disease is the cause of high mortality rates in CKD patients due to inflammation. Neutrophil to lymphocytes ratio (NLR) and platelet to lymphocyte ratios (PLR) are considered as inflammatory markers that are cheap, fast and easily calculated from the routine blood examination. This study aimed to know the value of RNL and RTL in CKD patients before and after HD as the initial marker of inflammation.

Method: Eighty-eight patients with CKD were divided into three groups before HD, after the first HD, and after the third HD. The neutrophil-lymphocyte ratio and platelet-lymphocyte ratio are calculated based on the results of routine blood tests. Data distribution was tested with Kolmogorov-Smirnov and analyzed by appropriate data testing.

Results: RNL and RTL values in CKD patients after HD increased compared to before HD (p <0.05). There is a weak correlation between RNL values and serum urea levels. However, the RTL value only correlates with urea before hemodialysis.

Conclusion: There are differences in RNL and RTL values in CKD patients before HD, after the first HD and third HD. There is a correlation between the RNL value and the state of uremia that is aggravated by HD

Analisis nilai diagnostik C-reactive protein pada pasien pediatrik dengan apendisitis di RSUP Dr. Wahidin Sudirohusodo, Makassar, Indonesia

Background : Acute appendicitis associated with acute phase reaction is the most prevalent disease which requires emergency surgery. Its delayed diagnosis and unnecessarily performed appendectomies lead to numerous complications. In our study, we aimed to detect the role of C-reactive protein (CRP) in the exclusion of acute and complicated appendicitis and diagnostic accuracy in pediatric age group.

Methods : A retrospective analytic observational study with cross-sectional design was performed on 69 children with definitive appendicitis. Appendectomized patient groups were constructed based on the results of histopathological evaluation. The area under a receiver operating characteristic (ROC) curve (AUC) was performed to examine diagnostic accuracy.

Results : Based on cut-off values of ≥ 22,6 mg/dL for CRP level, diagnostic parameters were as follow : sensitivity 97,4%, specificity 80,0%, PPV 97,4%, NPV 80,0%, and diagnostic accuracy 89,9%. AUC values were 0,98 (95% CI 0,96 – 9,99) for CRP.

Analisis amilase serum pre dan post-endoscopic cholangiopancreatography pada penderita kanker pankreas tahun 2017-2018 di RSUP Dr. Wahidin Sudirohusodo, Makassar, Indonesia

Background: Pancreatic cancer is a cancer of the thirteenth sequence of events worldwide and the fourth most common cause of death by some cancers. Amylase levels can increase if there is damage to pancreatic cells. Therapeutic ERCP procedure is expected to reduce amylase levels that are elevated in pancreatic cancer. This study aimed to evaluate the preand post ERCP serum amylase in pancreatic cancer patients.

Method: Observational retrospective using data from pancreatic cancer patients in January 2017 - January 2018 at the Laboratory of Clinical Medicine and Mechanical Installation of Dr. Wahidin Sudirohusodo Hospital, Makassar. Data were analysed using SPSS version 22 software for windows.

Results: Total of 39 pancreatic cancer subject aging 31–93 years were found, most of them were women. PreERCP amylase levels with a value of 167.5 ± 235.6 as against of 137.5 ± 159.4 in post ERCP. Some subject showed a decreased level and some showed an increased level. Statistical tests did not show significant results (Wilcoxon-signed rank test p> 0.05).

The association between wasting nutritional status and delayed of child development in children age 12 – 60 months in Wangaya General Hospital, Denpasar, Bali

Background: Sub-optimal nutritional status in Indonesia is still a continuing problem. There is no significant change in the prevalence of sub-optimal nutritional status. First 1000 days of life is a golden period of brain development. Failure of providing adequate nutrition can lead to the deviation of child development.

Objective: To investigate the association between wasting nutritional status and delayed child development

Methods: A cross sectional study was conducted in this study. Fifty eligible subjects were taken from April 2018 to July 2018 using consecutive sampling methods. Characteristics such as child age, sex, exclusive breastfeeding status, birth weight, birth height, current weight, current height, nutritional status, prematurity, and mother’s working status recorded. Child nutritional status was recorded and assessed with the WHO growth chart. Child developmental status was measured with the pre-screening development questionnaire (KPSP). Score ≤ 8 was assumed as a deviation in child developmental status.

Results: Wasting nutritional status is significantly associated with child development (p=0.041, CI -0.013-0.096). Prevalence ratio is 3.5 shows that wasting nutritional status is a risk factor for delayed child development. Domain for child developmental delay was 54,5% has language & speech delay, 36,4% has a gross motor delay, and 9,1% has social & independency delay.

Conclusion: There is an association between wasting nutritional status and delayed child development. The most often child developmental delay found is speech delay.

The effect of femoral head size on volumetric wear rate following total hip joint replacement surgery

Background: Numerous data records that the number of total hip joint replacement is increasing in many parts of the world which also indicates an increase demand for total hip joint replacement and revision surgery. The purpose of this paper is to review the literature regarding the size of femoral head and its relation to the volumetric wear rate of the polyethylene lining of the hip’s acetabular component.

Methods: A systematic literature search performed to identify relevant publications for this review in five databases: University of Melbourne Science, Medline/ Pubmed, Cochrane Library, and Ebsco. The search was completed on 6 October 2012 and again on 24 October 2012. The following keywords and phrases were used: total hip joint replacement, femoral head size, wear, polyethylene and arthroplasty.

Results: The six studies are all prospective cohort studies with a follow-up time ranging between three to ten years at the minimum. One study conducted by Hammerberg et al. did not mention the minimum length of their follow up however they include a mean follow up period which is 3.6 years. Two studies did not mention the number of patients they are following up. Every other studies mention how many participants included in their study, but these two studies mention how many hips undergo the total hip joint replacement surgery. The number of patients mentioned in the studies vary from the minimum of 42 patients up until 200 patients. The number of hips in each study ranged from 45 hips to 385 hips.

Conclusion: This review concludes that the use of larger femoral head size hastens the wear rate of the polyethylene lining of the acetabulum component.

Neuroendocrine tumor of the gastrointestinal: report of two cases

Introduction: Neuroendocrine tumors are malignancies that need special attention because they provide clinical manifestations that are not typical of excess gastrointestinal endocrine production. Case reports of neuroendocrine tumors are needed to be able to recognize the symptoms and determine the appropriate therapy.

Case series: The first patient was 49 years old Balinese female, consulted from internist with right lower-quadrant tenderness with fever for three days before. The patient also had diarrhea for one week before. The patient has done an appendectomy, and the pathological result of the appendix specimen was Neuroendocrine Appendix. The second patient was 62 years old Balinese male, complained about intermittent diarrhea for two months. Patient has done laparotomy exploration and colostomy because of a transverse colon tumor. The pathological result of the specimen from transverse colon tumor was mixed adeno-neuroendocrine carcinoma. Both patients have been treating with hormonal therapy (somatostatin analogs) long-acting release (LAR); the second patient also had combined with folfox IV chemotherapy.

Conclusion: The choice of therapy with somatostatin analogs in the first case and surgery in the second case gave a good response after treatment. However, in both cases, it does not guarantee the cure of this disease.

Acquired hemophilia – A pada penderita Waldenstrom’s Macroglobulinemia: laporan kasus

Background: Acquired hemophilia A (AHA) is a rare acquired bleeding disease, characterized by autoantibody against factor VIII. Bleeding usually in the skin and mucosal. AHA frequently in the elderly, in male and female and is associated with several conditions, such as autoimmune, pregnancy, drug reactions, solid tumor and monoclonal gammopathy. Half of patients are idiopathic. AHA is diagnosed in patients without previous personal or family bleeding history in which prolonged aPTT is not corrected after mixing and accompanied by a decrease in FVIII levels. Specific antibody that plays a role in inhibiting FVIII activity can be seen from the immonotyphing examination. Waldenstrom’s Macroglubulinemia (WM) is a one of disorders that can cause AHA.

Case Description: A 56-year-old man came with a weak and pale 10 days of hospitalized. Physical examination shown anemia, gum bleeding, lien palpable in Shuffner-1. Laboratory shown bisitopenia and leukocytosis, prolonged aPTT is not corrected after mixing with decrease FVIII levels. (BMP) support Chronic Lympocytic Leukemia/Lymphoma/ Smoldering Myeloma. SPE M-Spike with Immunotyphing examination of IgM lamda monoclonal. History, physical examination, laboratory, BMP, SPE, and immunotyping shown monoclonal gammophaty which cause Acquired Hemophilia A. Bethesda assay examination recommended if FVIII therapy is not responding. Lymphoplasmasitoid cells infiltration and monoclonal IgM production establishes diagnosis of WM.